We can’t help if he won’t engage…

We can’t help if he won’t engage…

What does that really mean?

It means that if you can fit into the one-size-fits-all service that was designed for neurotypical people with an ordinary upbringing and a lifestyle that means you can drop everything and travel to a destination of our choice…

Then, and only then, will we consider you engaged enough to help you.

To everyone else, well, you should have engaged.

That is, of course, only the first step to satisfying the rules of engagement.  The next step is that you must interact with us in a way that we would like you to.  In a way that we can understand and relate to.  In a way that fits our rigid models and frameworks that have been designed around the needs of people like us.  That you will be able to cooperate and receive help in a way that suits our narrow outlook and ‘one-size-fits-all’ service.

If you deviate from that, well, that’s not our fault, you should have engaged better.

I wonder if sometimes these rules of engagement are simply another way of rationing services?  If you have 100 referrals in a month, and 20 people can’t make it to your clinic you only have to see 80 and your waiting list will be shorter.

Shame about the other 20.  Still, if they won’t engage what can we do?

If you only see people in the clinic setting then some argue you can see more people in a day (though there may be evidence to dispute this).  Excellent – you don’t even need to see these people to screen them and demonstrate that they don’t ‘meet the criteria’ for onward support.  The stats that are collected about your service will look much better – superficially at least.  Your manager’s manager will leave your manager alone and focus elsewhere.

 

Every time “He needs to engage” is said we need to replace it with “How can we help him to engage?”

 

I feel as though I see this in all areas: education, health and social care.  It is easy to conclude that professionals working in these services lack imagination and the effort required to ensure their service reflects the needs of all of those who need it.  Where is the advocacy?  Why do they not work more flexibly and creatively?  These people could be construed as lazy, thoughtless and uncaring.  I don’t think, though, as a rule, the majority working in the care industries are lazy, thoughtless or uncaring but I do wonder if they have developed ‘learned helplessness.’

Learned helplessness

Apparently, this is when “This occurs when a person learns to believe that outcomes are not affected by their behaviour and are thus beyond their control“.  In short, when clinicians / teachers / social workers … are practising in a system that is rigid and unsupportive they begin to believe/learn that they can’t make a difference and stop trying.  They too become a victim of the system with lowering self-esteem and mood.  Many may have tried to rescue the human element of their service and learned that it simply won’t be allowed, or they carry on at huge personal cost and constant criticism from their peers and managers.

Screen Shot 2018-02-24 at 19.18.59

We need leaders that can really lead, in the widest sense.  Those that will and can challenge and change systems so that they are responsive to the needs of all our community, reflect too the needs of the people working in it and that can ensure that compassion is practised throughout.

In the meantime, it seems to me that those that ‘don’t engage’ will fall seriously by the wayside and the cost in both human and financial terms may be catastrophic.

Still, they should have engaged.

 

More on rationing here (in terms of excluding autism from mental health services) and here (in terms of bullying parents to make them disappear).

 

 

 

 

Advertisements

12 thoughts on “We can’t help if he won’t engage…

  1. I would be a wealthy person if I’d been given £1 for every time I’ve heard this regarding my son. He’s high functioning ASD, if he’d only engage, there are so many ways we could help him. My heart soars at the possibility, but yet again he doesn’t ‘engage’, lightbulb moment, maybe being on the spectrum means he can’t engage?! A shrug is all I’ve got so far, sometimes with an additional, ‘it must be hard for you’. I don’t need sympathy or empathy, my boy is so rewarding in so many ways, I just need someone to help him progress.

    Liked by 3 people

      1. Or, “Yes, I agree – and your training would have included knowing how to work with children with mental health issues and breaking through barriers to help them, including any resistance they feel.” (no question mark as it’s rhetorical, so the sentence doesn’t end with an enquiring tone but a flat statement). Followed by “Shall we ask him/her what they are struggling with regarding seeing you, so we can make according reasonable adjustments?” Hey, here’s an idea, why the heck don’t CAMHS have a form that asks those types of question so the child isn’t made to feel uncomfortable having it asked of them directly. Service user feedback needs to ask the right questions!

        Liked by 3 people

  2. I would like to turn this around, I agree with every single thing you have said. But I think it’s the CAMHS practitioners (et al) that are not engaging! They are clueless and I think in many cases it’s more than learned helplessness, I think it’s that they couldn’t give a crap. They just want to parrot what they have learned from training and manuals, which is clearly inadequate as it’s theoretical and doesn’t take real people into account, their individual personalities, circumstances and what works for them. Ironically people with ASD are supposed to be rigid but I would say CAMHS staff are way more rigid, perhaps they have an autistic collective attitude. Inability to perceive what others need and refusal to deviate from their preferred modus operandi. For children with ASD and most especially PDA, going to CAMHS appointments can be almost impossible. Or they manage to get there but find that the person they are faced with doesn’t have the competence to help them or persist in working with them in a way that’s right for them. It’s a complete failure in duty of care to discharge a child from the service because they are struggling to engage. Psychologists, psychiatrists and therapists should have the will to see that person as an individual and put down the rule book and keep going until they are successful. They should be flexible enough to provide home visits or meet at a place that the child feels is neutral. Sometimes autistic children don’t like the way the building looks or feels. CAMHS staff should also be prepared to change to a different practitioner when the child has a personal aversion to them, whether it’s the way they look, speak or smell. CAMHS should be prepared to offer female staff to female children, because many females feel intimidated or uncomfortable with male practitioners. It’s appalling what a failure CAMHS are, yes there are isolated successes where good practice has been evident, but as an entity CAMHS is the worst and fails so many children. Considering 1 in 10 children who use CAMHS are autistic, it’s beyond the pale that they get away with it. 4 years ago the Parliamentary inquiry into CAMHS reports on widespread failings, since then there have been NAS reports etc. and widespread media articles about mental health services failing children with mental ill-health. Why has nothing changed all this time later?!

    “CAMHS and autism: A story in pictures…”
    https://planetautismblog.wordpress.com/2014/06/23/camhs-and-autism-a-story-in-pictures/

    ““CAMHS and Autism – A Story in Pictures” Episode 2”
    https://planetautismblog.wordpress.com/2017/02/27/camhs-and-autism-a-story-in-pictures-episode-2/

    Liked by 1 person

  3. Reblogged this on Planet Autism Blog and commented:
    I would like to turn this around, I agree with every single thing this blog post has said. But I think it’s the CAMHS practitioners (et al) that are not engaging! They are clueless and I think in many cases it’s more than learned helplessness, I think it’s that they couldn’t give a crap. They just want to parrot what they have learned from training and manuals, which is clearly inadequate as it’s theoretical and doesn’t take real people into account, their individual personalities, circumstances and what works for them. Ironically people with ASD are supposed to be rigid but I would say CAMHS staff are way more rigid, perhaps they have an autistic collective attitude. Inability to perceive what others need and refusal to deviate from their preferred modus operandi. For children with ASD and most especially PDA, going to CAMHS appointments can be almost impossible. Or they manage to get there but find that the person they are faced with doesn’t have the competence to help them or persist in working with them in a way that’s right for them. It’s a complete failure in duty of care to discharge a child from the service because they are struggling to engage. Psychologists, psychiatrists and therapists should have the will to see that person as an individual and put down the rule book and keep going until they are successful. They should be flexible enough to provide home visits or meet at a place that the child feels is neutral. Sometimes autistic children don’t like the way the building looks or feels. CAMHS staff should also be prepared to change to a different practitioner when the child has a personal aversion to them, whether it’s the way they look, speak or smell. CAMHS should be prepared to offer female staff to female children, because many females feel intimidated or uncomfortable with male practitioners. It’s appalling what a failure CAMHS are, yes there are isolated successes where good practice has been evident, but as an entity CAMHS is the worst and fails so many children. Considering 1 in 10 children who use CAMHS are autistic, it’s beyond the pale that they get away with it. 4 years ago the Parliamentary inquiry into CAMHS reports on widespread failings, since then there have been NAS reports etc. and widespread media articles about mental health services failing children with mental ill-health. Why has nothing changed all this time later?!

    “CAMHS and autism: A story in pictures…”
    https://planetautismblog.wordpress.com/2014/06/23/camhs-and-autism-a-story-in-pictures/

    “CAMHS and Autism – A Story in Pictures” Episode 2”
    https://planetautismblog.wordpress.com/2017/02/27/camhs-and-autism-a-story-in-pictures-episode-2/

    Like

  4. And you know, the cover-up culture is so widespread in the NHS that even if you speak to the top person at CAMHS, they defend their staff to the nth degree, won’t admit failings and won’t change anything, so is it any wonder the staff have total complacence about the service they are providing? That’s not learned helplessness that’s defending the indefensible. They spend so much time having meetings, that there is not enough time to help all the children queueing outside even if they had the skills. And they are arrogant, my word are they arrogant. When you have clinicians shushing you for trying to assist your vulnerable child who has a communication disorder answer a question when they are tongue-tied and needs advocacy from their parent, or they write nasty things about parents on children’s files (which is rife), that’s nothing to do with lack of funding. It’s a fundamental disrespect for parents, we are the professionals we know best attitude.

    Liked by 1 person

  5. Every single time, the first sentence to my autistic child, was “no one can force you but …”
    well he didn’t hear anything else from there on in, it’s what he wanted to hear, the rest was already lost on him. Then came ‘he won’t engage, what do you want us to do?’

    Stop empowering him, he was 8 at the time! Be the adult and tell him what’s going to happen!

    Liked by 1 person

  6. This was all I heard regarding my sons education but he engages just fine now he is home educated. ‘we can’t teach him if he wont engage’, the truth is he couldn’t engage in learning with the situation they provided as proved by the fact he can and does now
    .

    Liked by 2 people

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s